THE CARE OF USER WITH DIABETES MELLITUS TYPE 2: A RESEARCH BIBLIOGRAPHY 1 ABSTRACT

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1 THE CARE OF USER WITH DIABETES MELLITUS TYPE 2: A RESEARCH BIBLIOGRAPHY 1 SILVA, Marciele Moreira da 2 ; BUDÓ, Maria de Lourdes Denardin 3, SILVA, Silvana de Oliveira 4, EBLING, Sandra Beatris Diniz 5 ; CARVALHO, Sandra Ost Rodrigues Martins 6, ABSTRACT This study is a bibliographic research that aimed to know the production of existing knowledge about the care of user with Diabetes Mellitus Type 2, aiming to identify the dimensions and aspects that involve this care.the search of the data was performed in July 2011, in databasesliteratura da América Latina e Caribe em Ciências da Saúde and Medical Line, obtaining a totalresult of 140 articles, of which 15 constitute in material of thematic analysis.the results direct that the care in studies is developed by different actors and in various scenarios, contemplating categories as Care focused on disease control; Care based on the experience of illness; Diabetes mellitus type 2 and the care practices. It was evidenced a care permeated by biomedical implications, that consider only the care under the focus of monitoring and control of pathology based on behavioral changes and life styles. Descriptors:Chronic Disease; Diabetes Mellitus; Nursing Care. 1. INTRODUCTION The Diabetes Mellitus (DM) Type 2 is an important public health problem, being pathology of multiplesetiologies, resulting from the absence of insulin and/or disability of the insulin to exercise their effects adequately. 1 1 Research Study. Universidade Federal de Santa Maria (UFSM). 2 Presentor. Nurse. Graduate Study Master at UFSM. Teacher of Nursing Course at Universidade Regional Integrada do Alto Uruguai e das Missões (URI), Santiago, RS, Brazil. Member of the Research Group Care, Health and Nursing the UFSM. enfmarciele@yahoo.com.br. 3 Nurse. Nursing Doctor. Nursing Teacher at UFSM, Santa Maria, RS, Brazil. 4 Nurse. Nursing Master. Co-ordinater of Nursing Course at URI, Santiago, RS, Brazil. 5 Nurse. Education Master. Teacher of the Nursing Course at URI, Santiago, RS, Brazil. 6 Nurse. Graduate Study Master at UFSM. Teacher of Nursing Course at URI, Santiago, RS, Brazil. Member of the Research Group Care, Health and Nursing the UFSM.

2 Despite of the advances in research and new technologies of care, many people still die from complications caused by diabetes. This situation can to be resulting of gaps existents in health care of these individuals that most of the times are only perceived when are decompensate and when search the hospital emergencies with compromising renal, cardiac, vascular, among other. In this logic, the health care focused on patients with diabetes even is proportioned of form fragmented and reductionist, without integration between the levels of attention, putting in questioning the resolvability and the integrality in health care. The professionals focalized the control and monitoring of the pathology, as well as in the vertical transmission of information, resulting in care practices authoritative that disregard the reality lived by peple. 2 So the knowledge about the care becomes important once the DM Type 2 as a chronic disease that affect millions of people in all world and it has motivated the search of focus and methodologies that make a true vision of the problem, principally about the knowledge, perceptions, attitudes, fears and the practices of the patient, professionals and health services, in the family context and communitarian. Based on this logic, wonders: What is the production of existing knowledge related to the care to patients with DM Type 2? What are the aspects and dimensions that permeate this care? In this sense, the aim of this bibliographic research was to know the production of existing knowledge about the care of the users with Diabetes Mellitus Type 2, aiming to identify the dimensions and aspects that involve this care. 2. METHODOLOGY In the month of July 2011, was performed a literature research with aim to make a survey on the panorama of the scientific production produced in Brazil and in foreign about the themes "Care and Diabetes Mellitus". The research was conducted in Virtual Health Library (VHL), being used the databases: Literatura da América Latina and Caribe em Ciências da Saúde (LILACS) e Medical Line (MEDLINE). The search of the articles was made with the subject descriptors: "Diabetes Mellitus" and "Diabetes Mellitus, Type 2", according to the Descriptors in Health Sciences (DeHS), and as keywords: "Care, Self Care, Knowledge and Practices". It is highlight that we used the Boolean operator AND and the search occurred in all indices, without time temporal period. In this search were found a total of 126 articles in MEDLINE and 14 articles in LILACS. It was established as criterion for selection: original articles published in journals,

3 full text available on electronic support, in Portuguese, English and Spanish and which serve the objectives of the study. The exclusion criterion were monographs, theses, dissertations, abstract not available online and not correctives to the theme. After the read the title and of abstracts were selected a total of 15 articles to the analysis, which were to the meeting of the theme. Starting from a qualitative analysis was performed a floating reading and exhaustive of abstracts, the construction of corpus, data processing and interpretation. 3 In the sequence the articles were catalogue in synoptic application adapted and organized as follows: authors, title, objective, characterization of the study, subjects, periodic/years/basis and conclusion. 4. RESULTS E DISCUSSION It is evident that six researches are of type quantitative, five are qualitative and four are qualitative and quantitative. The year 2009 corresponds to the largest number of jobs, being that there were five productions, followed in 2010 with three, 2008 and 2002 with two jobs and in the years 2000, 2004 and 2007 with only one production each. This research found that the largest number of publications was between Brazil and the United States, with five articles each, followed by England with three productions, after Ireland and China with a production. Relative the area of knowledge the nursing produced seven articles, the Medicine six articles. In this perspective the thematic care has been explored with greater emphasis by courses in the area of health, particularly in nursing and medicine. In addition of this characterization, it was found in the studies that the care is developed by different actors and in various scenarios. In the fifteen studies analyzed, seven studies had as subject the users with DM Type 2 and in four studies the health professionals and health services were the focus of the study. In this way, it is observed that the productions include the care under a professional vision or institutional, that does not consider the user as being able of to care. In the category Care Centered in the Control of the Disease was perceived the predominance of studies directed rationality hegemonic medical centered in health practices and care only under the biological focus of the patients with DM. Several studies focus only the care that valorizes the behavioral changes and the life style of the users. 4,5,6 It is evident a care centered in fixed protocols as the feed reeducation, physical activity, care with the medication, particularly to insulin therapy in most productions. The

4 concept of care is limited to maintenance of the disease, ignoring other aspects imbued in the process care-health-disease. 7,8 The fear of reality experienced by people with diabetes mellitus is not part of the practices of care because they are focalizes in the mode of attention directed to the sick body. In addition, the researches showed that the care is perceived only as an act of the health professional because the conduct of the care is markedly biomedical and professional centralized. 9,10 In the category Care based on the experience of illness the studies discuss the aspects relative to the diabetes and the experience of illness as part of the process of care. Among the fifteen articles researched only two treated about the care valorizing the knowledge of user with diabetes. 11,12 One study found understands the experiences and existences of care from the reflection of user with diabetes. In this study all the actors involved (users, professionals and management) are acting only in the superficiality of the process of illness and care because they ignore the reality experienced by people with DM Type 2. Another study is about the interpretation of meanings and the representation of pathology for the life of patients with DM Type 2 and complications how the diabetic foot. The subjects point difficulties with the physical limitations, fear of death, meanings about the disease and conflicts present in the health services. For the subjects there is influence of the knowledge about the disease, which contributes to the struggle for survival and the maintenance of its social role. The authors say that to know and learn about the disease from the user perspective is possible to acknowledge the deficiency of their abilities for the self-care. It still allows the health professionals can to familiarize with the day-to-day, understanding issues that arise when you live with diabetes. However, the study indicates the understanding about the disease, not focusing on the knowledge and care practice. In the category Diabetes Mellitus Type 2 and the Care Practices the publications bring a care focused on disease, with individual focus and medicalized and with little use of health education activities in the daily of health practices. 13,14,15 The care practices in the health services are supported in actions medicalizing and normative strongly influenced by the model clinical. 16 Only one of the publications reported the approach multidisciplinary how a strategy that allows the education and care in diabetes, directing the practice for the visit domiciliaria. 13

5 The use of technology comes with the purpose to give support to individuals with DM Type 2 and to give new care practices. In the two studies found your research problem was in the evaluation of the technologies in the care process. 17,18 It should that these studies only had the objective to evaluate the membership of the users to utilization of technology. 4. CONCLUSION The result of this research reveals the lack of studies about the thematic care related to DM Type 2. We identified that the interest to this thematic had space only in the last two years because of the fifteen studies only two study had as central focus the care under a holistic perspective. This study showed a care provided by different people, users, professionals, but also by health services, being this permeated by biomedical implications that consider only the care under the approach for the monitoring and control of pathology based on behavioral changes and life styles. We believe to be fundamental to transcend the biologistic vision and culpabilizante with that is structuring the care for the user with diabetes, implementing of actions focused on users, allowing them be co-sharers in the construction of the care. New studies should to be performed in order to identify the best way to know as the care is perceived in the context of DM Type 2 in order to recognize and to attend the health needs of people and the experience these conditions in search of the integral care. REFERENCES 1 Comiotto G; Martins JJ. Promovendo o autocuidado ao indivíduo portador de diabetes: da hospitalização ao domicílio, ACM arq. catarin. med;35(3):59-64, Faria APS. A experiência de adoecimento e a busca por cuidado empreendida pela pessoa com diabetes mellitus Dissertação (Mestrado em Enfermagem), Faculdade de Enfermagem da Universidade Federal de Mato Grosso, Cuiabá, Minayo MCS. O desafio do conhecimento: pesquisa qualitativa em saúde. 11 ed. São Paulo: HUCITEC/ Rio de Janeiro: ABRASCO; Cotta RMM et al. Hábitos e práticas alimentares de hipertensos e diabéticos: repensando o cuidado a partir da atenção primária Rev. nutrição; 22(6): , 2009.

6 5 king de; Mainous AG; Carnemolla M; Everett J. Adherence to healthy lifestyle habits in US adults, Am J Med; 122(6):528-34, Venters JY; Hunt AE; Pope JF; Molaison EF. Are patients with diabetes receiving the same message from dietitians and nurses? Diabetes Educ; 30(2): , Paul GM et al. Peer support in type 2 diabetes: a randomised controlled trial in primary care with parallel economic and qualitative analyses: pilot study and protocol BMC Fam Pract; 8:45, Tang PL; Yuan WL; Tseng HF. Clinical follow-up study on diabetes patients participating in a health management plan. J Nurs Res; 13(4):253-62, Jorgensen WA; Polivka BJ; Lennie TA. Perceived adherence to prescribed or recommended standards of care among adults with diabetes Diabetes Educ; 28(6):989-98, Taylor CD; Hendra TJ. The prevalence of diabetes mellitus and quality of diabetic care in residential and nursing homes. A postal survey. Age Ageing; 29(5):447-50, Faria APS; Bellato RA vida cotidiana de quem vivencia a condição crônica do diabetes mellitus Rev. Esc. Enferm. USP;43(4): , Coelho MS; Silva DMG; Padilha MIS. Representações sociais do pé diabético para pessoas com diabetes mellitus tipo 2 Rev. Esc. Enferm. USP; 43(1), Torres HC; Roque C; Nunes C. Visita domiciliar: estratégia educativa para o autocuidado de clientes diabéticos na atenção básica. Rev. enferm. UERJ; 19 (1):89-93, Begum S; Por J. The impact of the NSF for Diabetes on patient empowerment, J Nurs;19(14):887-90, Souza MLP; Garnelo L. É muito dificultoso: etnografia dos cuidados a pacientes com hipertensão e/ou diabetes na atenção básica, em Manaus, Amazonas, Brasil. Cad. saúde pública; 24(1):91-9, Hosler AS; Godley K; Rowland DH. An initiative to improve diabetes care standards in healthcare organizations serving minorities. Diabetes Educ; 28(4):581-9, Siminerio LM. The role of technology and the chronic care model. J Diabetes Sci Technol;4(2):470-5, Haller NA; Gil KM; Gardner WG; Whittier FC. Patient computer use to prompt doctor adherence to diabetes management guidelines J Eval Clin Pract;15(6): , 2009.